Vickery Pediatrics LLC Financial Policy Revised 1/1/2015 Thank you for choosing Vickery Peds as your child’s healthcare provider. Payment is required at the time of service; non payment will result in either your child not being able to see one of our providers or a $25 billing fee added to your account. These fees can not be waived. The following is a statement of our Financial Policy which we do require you to read and sign prior to your child’s appointment. Due to the frequent changes in healthcare coverage, we require that you provide proof of valid insurance coverage and a driver’s license at each visit. If you do not have verifiable insurance coverage, or do not have a copy of your insurance card with member and group id, or are on a plan that we do not participate in, full payment is required at time of service prior to being seen by our providers. Please ask our front desk staff about our Vickery Peds same day discount. Co pays, Deductibles and Coinsurance All co pays, deductibles and coinsurance amounts are due at time of service per your insurance policy. As always, for your convenience we accept cash, check, Visa, MasterCard, Discover and American Express. We will now hold a credit or debit card on file, once your claim has been processed through your insurance company and you receive your EOB (explanation of benefits) your card will be charged for the patient responsibility balance per your contract with your insurance company. When we receive a copy of the finalized EOB claim, you will receive a courtesy email from us stating your card will be charged within 2-3 days. Contractual Insurance Although we participate with your insurance company, some procedures done in our office are not covered per your individual plan contract. These non covered charges are your responsibility. We will routinely file your claims to your insurance company each visit. Any questions of coverage or payment discrepancy need to be directed to your insurance company. You will be required to pay the balance as you work with your insurance company to resolve the issue. If your insurance company has not paid Vickery Pediatrics within 90 days from the date of service, the balance will be transferred to you and due upon receipt. Please keep in mind your insurance policy is a contract between you and your insurance company: therefore all remaining balances are your responsibility. If your account goes unpaid by you after 90 days, it will be sent to outside collections and you will be dismissed from our practice. Account fees We will charge a 1.5% interest monthly as provided by Georgia State law, on any balances over 60 days. If your personal check is returned for insufficient funds, you will be asked to make immediate payment in form of cash or credit card plus a NSF fee of $35. These charges will be added to your account and must be paid within 7 days to avoid further collection activity. Miscellaneous fees Participation and clearance forms for camp, school, sports etc completed outside of normal annual physicals will be charged a $10 processing fee in advance. Nurse Visits If your child is seen by one of our nursing staff for blood work, hearing and vision screens etc; it is billable to insurance and will require collection of a co pay, deductible or coinsurance on the day of service. No Show and cancellation fees Patients who “NO” show for an appointment will be charged a $50 broken appointment fee. Our office requires 24 hours notice to cancel an appointment. If you need to cancel outside normal business hours you can leave a message with our answering service. Delinquent Accounts If your account has an outstanding balance and full payment ca not be made, you must contact our office and set up a payment plan to avoid being sent to collections. All payment plans are set up as follows: 50% of the total balance due will be collected and then equal monthly payments of $50-$100 per month will be charged on the day you choose monthly with the card we hold on file. You will be charged 1.5% interest monthly as long as you are in a payment plan. You will receive monthly statements to reflect payments made to your account. If a payment is declined you will have 7 days to pay total balance due on the account to avoid outside collections. Failure to pay all outstanding balances will result in your account being turned over to an outside collection agency. If your account is turned over to collections your family will be dismissed from our practice and a 30% collection fee will be added to your outstanding balance. It is your responsibility to find another provider for your child. We will continue to see your child during the 30 day transition on an emergency “Cash “pay basis only. Vickery Pediatrics may need to disclose to a collection agency personal health information related to receiving payment for services rendered in the event your account becomes delinquent. All patients are asked to check out prior to leaving after each visit; it is unlawful to intentionally walk out without paying for services rendered by our providers. Thank you for understanding our Financial Policies. Pleas let us know if you have any questions. Vickery Pediatrics
Posted on: Wed, 31 Dec 2014 15:25:05 +0000
Trending Topics
Recently Viewed Topics
© 2015